COVID-19 Challenges Our Faulty Assumptions About Normative Wellbeing

Lucy Johnstone addresses how limitations to models for psychological health and treatment have been spotlighted during the COVID-19 pandemic–which may not be a bad thing.

Sadie Cathcart
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In a manuscript recently accepted to BJPsych Bulletin, released in a pre-print format, psychologist Lucy Johnstone calls for a drastic shift in the discourse surrounding wellbeing in the context of COVID-19. She writes that the conceptualization of the COVID-19 pandemic as parallel yet separate from an epidemic of “mental health” has the effect of minimizing appreciation for contextual determinants of distress. According to Johnstone:

“In the current jargon, popular in both psychology and psychiatry, we need a [re]formulation – a shift from ‘patient with illness’ to ‘person with a problem.'”

Johnstone seeks not to downplay the substantial, widespread implications of loss and uncertainty associated with COVID-19, but to reframe how we think and talk about them. Among her chief concerns is that the narrative of a “mental health crisis” prevalent in the media misrepresents the existing research. She cites one sizeable, longitudinal survey study suggesting immediate distress related to disease precautions followed by trend indicating longer-term coping and resilience.

“COVID-19 and its consequences are not hitting us all equally. In ordinary language, people with more to be exhausted, depressed, and anxious about are feeling more exhausted, depressed, and anxious. However, the general picture is, in the words of the researchers, of a population which is ‘largely resilient.'”

Survey results also indicated that those experiencing sustained distress were more likely to have been challenged by circumstantial disadvantages such as pre-existing conditions, exposure to the virus, families to manage, etc. The water was already murky in the pursuit of disentangling clinically significant distress from circumstantial demands of a person. The spread of COVID-19 has further complicated matters.

“People who have lost their jobs are likely to feel desperate, but we don’t have to describe this as ‘clinical depression’ and prescribe drugs for it. Those with backgrounds of severe trauma may find that their worst memories are being triggered, but we don’t have to describe this as a relapse of their ‘borderline personality disorder.’ The economic recession that will follow the pandemic may lead to as many suicides as austerity measures did, but we don’t have to say that ‘mental illness’ caused these deaths.”

Johnstone notes that behaviors that might have historically been considered abnormal may be protective in the context of a pandemic. Although constant hand washing and avoidance of social circumstances may have traditionally been considered problematic, these are now (in some settings) acceptable – encouraged, even. In the absence of biomarkers to indicate most psychological disorders, diagnostic determinations can be tenuous. The pandemic has made it all the more challenging to tease out abnormal behavior but may also be inspiring fresh ways of thinking about “mental health.”

Some of the language used in public service announcements surrounding anxiety, loneliness, and feelings related to depression during the pandemic – including those acknowledging the idea that distress is expected during such a time – puts the onus on people to “speak up” about mental health and “seek help.” A snorkel in a tidal wave. In relation to COVID-19, a wave primarily impacting people with other vulnerabilities, Johnstone adds:

“Not a single new research study is needed to confirm that being poor, jobless, isolated, ill, and bereaved makes people unhappy, or to work out the appropriate remedies.”

Is prolonged distress indicative of “illness” when experienced amidst isolation, food and housing insecurity, and medical risk? If the pandemic-related “tsunami of mental illness” anticipated by some psychologists and psychiatrists is realized only among those most proximally impacted by COVID-19 and precautions, is psychology the ideal entry point for intervention? Johnstone believes the best options in alleviating distress include initiatives in which “participation, community, trust, and connection [are] valued over status, individualism, and competition.”, as advised by Psychologists for Social Change.

Johnstone offers that as an alternative to thinking about sustained psychological distress as something wrong with a person, it may be more useful to focus on what has happened to a person – understanding distress and pain as “meaningful patterns of responses to threats.” She suggests that one of the risks of attributing distress to mental illness is the pattern of then compartmentalizing feelings that one may ultimately have benefitted from staying better connected to.

Conflating loss of hope, for example, associated with job loss, stress surrounding tasks required of raising children in the context of COVID-19 precautions, and lack of social opportunity with psychological disorder may be detrimental to wellbeing. Rehabilitating community systems and creating new programming when not to support the overall quality of life could set the wheels in motion for healing that, Johnstone believes, could far surpass the therapeutic benefits of available psychological treatment options.

 

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Johnstone, L. (2020). Does coronavirus pose a challenge to the diagnoses of anxiety and depression?: A psychologist’s view. BJPsych Bulletin, 1-10. DOI:10.1192/bjb.2020.101 (Link)

7 COMMENTS

  1. “Johnstone believes the best options in alleviating distress include initiatives in which ‘participation, community, trust, and connection [are] valued over status, individualism, and competition.’”

    Shouldn’t it have always been that way? A question for those obsessed with calling themselves “professionals.”

    “Johnstone offers that as an alternative to thinking about sustained psychological distress as something wrong with a person, it may be more useful to focus on what has happened to a person.”

    Dah, but this has been a major flaw in the logic of the psychologists for decades. Especially since none of the so called DSM “mental illnesses,” that the psychologists defame people with, have any scientific validity whatsoever.

    https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml

    There are many, many “risks of attributing distress to mental illness.” And doing such made no logical sense, in the first place.

    The psychologists’ DSM belief system is insane, scientifically invalid, and has already been debunked. The psychologists need to come to grips with reality, flush their “bible,” stop defaming people with invalid “mental illnesses,” and stop force neurotoxic poisoning people with drugs, about which they know nothing.

    There never was, and still isn’t, anything “professional” about defaming and poisoning people. Since both defaming and poisoning people are illegal behaviors.

    • ‘There never was, and still isn’t, anything “professional” about defaming and poisoning people. Since both defaming and poisoning people are illegal behaviors.”

      Areed SE. Although we have heard the term “professional criminal”. Even for those, there used to be and still exists on some level, reconciliation within the “justice system”. Where criminal and victim come face to face and talk about what happened. But the present justice system and no influential person within it has had the courage to stand up to the original hoax, nor the drug industry and it’s baby, the FDA. It will take a few, it will take one, and a few followers internally, to turn it into the brave act that we could look back on.
      But they fear being out of jobs, of not being successful in exposing the harms and the invented “illness”.

      They still are stuck in the muck of seeing that person with “problems” and feeling that there has to be something “wrong with them” and that they need “service”. It always takes them back to thinking they need psychiatry, when the service of psychiatry is a huge part of the “problem” and acts like a smokescreen so no one should see what in fact the many issues are.

  2. ““In the current jargon, popular in both psychology and psychiatry, we need a [re]formulation – a shift from ‘patient with illness’ to ‘person with a problem.’”

    Lucy is correct here. And it is never the “person” themselves, for if one has or had a “problem”, it went way beyond the person.
    What a hoax the men of psychiatry created, out of their own problems. It was always about the blind “treating” the blind and nothing but chaos results out of such endeavors.
    One would think that by now, psychiatry would be aching to voluntarily leave and have that TALK with everyone regarding “problems” and how we can at least try to start fixing them.

    Psychiatry and much of the systems engaging in the lies, is employment and that is what keeps a system going, at least until it breaks down or is taken down.

  3. If I could kiss an article, it’d be this one. This is EXACTLY what I’ve been telling people. It’s perfectly reasonable to feel like shit right now because there are some extraordinarily massive shitty things going on! Being stressed during a pandemic isn’t some biological disease that you need to fix with drugs; it’s a natural reaction to stress!

  4. Sadie and Lucy, my earlier article in MIA, “Is COVID-19 Making Everybody Crazy?” https://www.madinamerica.com/2020/07/covid-19-making-everybody-crazy/ (of course, the answer is “Upset, yes, but mentally ill, no”) is a good pair with this one. One of the points I made was that calling people’s upset “mental health problems” is WRONG and DANGEROUS precisely because it conveys to many people that “mental health problems=psych disorders.” Instead, we should use old-fashioned, accurate terms for these feelings, like “scared,” “angry,” “disoriented,” “hopeless,” “grieving,” etc.

    • Very true Paula. It is truly awful what has been done with responses and learned responses, or learning styles. The list of differences and capabilities in humans is endless. Obviously we need to get back to true words, true meanings and stop making up meaningless crap that helps no one. “mental illness” seems to be the only illness where “diagnosing” leads to worsening. “doctor” I am depressed”. “You have depression”
      Brilliant.
      To make it sound sciency, bi-polar is thrown in. And words of defense by psychiatry and medicine is something called “spectrum”, “spectrum” is used, to say that you are still “disordered”.

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